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STATUS REPORT ON MISSOURI'SSUBSTANCE ABUSE AND

MENTAL HEALTH PROBLEMS

17th Edition - 2011

MISSOURI DEPARTMENT OF MENTAL HEALTHDivision of Alcohol and Drug Abuse

DIVISION OF ALCOHOL AND DRUG ABUSEAAD

STATUS REPORT ON MISSOURI’S SUBSTANCE ABUSE AND MENTAL HEALTH PROBLEMS

SEVENTEENTH EDITION — 2011

Randall C. Smith, M.P.A., M.Ed.

Christie J. Lundy, Ph.D.

Renee M. Rothermich, M.A.

MISSOURI DEPARTMENT OF MENTAL HEALTH Divisions of Alcohol and Drug Abuse and Comprehensive Psychiatric Services

1706 East Elm; P.O. Box 687 Jefferson City, MO 65102

(573) 751-7814 Fax

http://www.dmh.missouri.gov/ada/rpts/status.htm

Keith Schafer, Ed.D. Director, Department of Mental Health

Mark Stringer Director, Division of Alcohol and Drug Abuse

Acting Director, Division of Comprehensive Psychiatric Services

Steve Reeves Deputy Director, Divisions of Alcohol and Drug Abuse and

Comprehensive Psychiatric Services

Clive Woodward Director of Research and Statistics, Divisions of Alcohol and

Drug Abuse and Comprehensive Psychiatric Services

StatisticsR

esea

rch

ADA CPS

2011 Status Report on Missouri’s Substance Abuse and Mental Health Problems Page A-2

The Department of Mental Health does not deny employment or services because of race, sex,

creed, marital status, religion, national origin, disability or age of applicants or employees.

JEREMIAH W. (JAY) NIXON GOVERNOR

KEITH SCHAFER, Ed.D. DIRECTOR

STATE OF MISSOURI

DEPARTMENT OF MENTAL HEALTH 1706 EAST ELM STREET

P.O. BOX 687

JEFFERSON CITY, MISSOURI 65102

(573) 751-4122

(573) 751-8224 FAX

www.dmh.mo.gov

MARK STRINGER

DIRECTOR

DIVISION OF ALCOHOL AND DRUG ABUSE

(573) 751-4942 (573) 751-7814 FAX

and

ACTING DIRECTOR DIVISION OF COMPREHENSIVE

PSYCHIATRIC SERVICES (573) 751-8017

(573) 751-7815 FAX

BERNARD SIMONS DIRECTOR

DIVISION OF DEVELOPMENTAL DISABILITIES

(573) 751-4054 (573) 751-9207 FAX

PREFACE

This 17th Edition of the Status Report brings an expansion of contents and a name change. Since its first release in 1995 the annual Status Report on Missouri’s Alcohol and Drug Abuse Problems has presented survey data, state and county-level indicators of substance abuse, and clinical treatment admissions in Division of Alcohol and Drug Abuse programs. The Status Report provides useful data for prevention and treatment needs assessments, services planning, and program evaluation. Some individuals have a combination of problemsrelated to substance abuse, mental health, physical health, family relations, education, employment, legalissues, or other serious concerns. An appropriate and effective treatment system requires a collaborative approach among behavioral health services agencies supported by integrated data analysis. Earlier this year, the Missouri Department of Mental Health convened the Missouri Behavioral Health Epidemiology Workgroup. Comprised of data specialists from several state agencies, the Workgroup is developing a system to identify, collect, monitor, integrate, and analyze a more comprehensive set of substance abuse, mental health, and related data. This publication’s name change to Status Report on Missouri’s Substance

Abuse and Mental Health Problems reflects the Department’s commitment to that project. This edition of the report includes some additional mental health indicators and the first-time presentation of clinical data from the Division of Comprehensive Psychiatric Services.

Inquiries and comments should be directed to the Division of Alcohol and Drug Abuse, Research and Statistics office at: mailto:[email protected].

Prior editions of the Status Report are accessible at this website: http://www.dmh.missouri.gov/ada/rpts/status.htm

Sincerely, Mark Stringer

http://www.dmh.mo.gov/

mailto:[email protected]

http://www.dmh.missouri.gov/ada/rpts/status.htm

Ron Beck, Missouri Department of Public Safety

Joellyn Becker, Missouri Department of Mental Health

Karin Bosh, Missouri Department of Health and Senior Services

Karen Breejen, Missouri Institute of Mental Health

Gerard Callahan, Missouri Department of Public Safety

Lindsay Crow, University of Missouri—Columbia

Avera Daniels, Missouri Department of Corrections

Susan Depue, Missouri Institute of Mental Health

John Doyle, Missouri Department of Public Safety

Lisa Eastman, Missouri Department of Health and Senior Services

Bill Elder, University of Missouri, Office of Social and Economic Data Analysis

Susan Elder, Missouri Department of Health and Senior Services

Sara Herman, Missouri Office of State Courts Administrator

Art Hughes, U.S. Substance Abuse and Mental Health Services Administration

Anne Janku, Missouri Office of State Courts Administrator

Jeremy Kintzel, Missouri Department of Health and Senior Services

Rebecca Kniest, Missouri Department of Social Services

Denise Lehmen, Missouri Department of Revenue

Tracy Lehmen, Missouri Department of Public Safety

d hf ld f l h d

ACKNOWLEDGMENTS

The authors would like to recognize and thank many individuals and their agencies, including the following, for their

contributions of data and support in producing this 17th Edition of the Status Report:

David Litchfield, Missouri Department of Health and Senior Services

Joan Masters, University of Missouri—Columbia

Michael McBride, University of Missouri—Columbia

Rick McElfresh, Missouri Office of State Courts Administrator

Kimberly McKane, Missouri Department of Social Services

Richard Morrisey, Missouri Office of State Courts Administrator

Tom Ogle, Missouri Department of Elementary and Secondary Education

Mary Pearce, Missouri Department of Elementary and Secondary Education

Angella Plunkett, Missouri Office of State Courts Administrator

Liz Sale, Missouri Institute of Mental Health

Kirsten Schaefer, Missouri Department of Social Services

Dewayne Sprenger, Missouri Department of Public Safety

Angie Stuckenschneider, Missouri Department of Mental Health

Lois Thomas, Missouri Department of Mental Health

Margaret Tyler, Missouri Department of Health and Senior Services

Mark VanTuinen, Missouri Department of Health and Senior Services

Clive Woodward, Missouri Department of Mental Health

Shumei Yun, Missouri Department of Health and Senior Services

2011 Status Report on Missouri's Substance Abuse and Mental Health Problems Page A-4

SECTION A: NARRATIVES AND DATA ANALYSIS PAGE #

Introduction and Data AnalysisReport Cover A1

Title Page A2

Preface A3

Acknowledgments A4

Table of Contents A5-A9

Highlights

Prevalence of Substance Abuse A10

Prevalence of Mental Illness A11

Substance Abuse and Mental Illness Related Deaths A12

Substance Abuse Related Hospital Episodes A13

Substance Abuse Related Traffic Crashes A14

Alcohol and Drug Arrests A15

Juvenile Court Services A16

Corrections Supervision A17

Substance Abuse Treatment Services A18

Mental Illness Treatment Services A19

Looking Ahead A20

Annual Updates

About the Surveys -- A Quick Reference A21-A24

Restricting Youth Access to Tobacco A25-A26

SECTION B: UNITED STATES AND MISSOURI PREVALENCE SURVEYS IN TABLES AND CHARTS

National Survey on Drug Use and Health -- TablesPast-Month and Lifetime Substance Use (%): U.S. Ages 12 and Older, 1997-2009 B1

P t M th d Lif ti S b t U (%) U S A 12 17 1999 2009 B2

TABLE OF CONTENTS

Past-Month and Lifetime Substance Use (%): U.S. Ages 12-17, 1999-2009 B2

Past-Month and Lifetime Substance Use (%): U.S. Ages 18-25, 1999-2009 B3

Past-Month and Lifetime Substance Use (%): U.S. Ages 26 and Older, 1999-2009 B4

Substance Use, Problems, and Perceptions (%): U.S. and Missouri Age Groups, 2007/2008 B5

Substance Use, Problems, and Perceptions (#): U.S. Missouri Age Groups, 2007/2008 B6

Youth Risk Behavior Survey -- TablesAlcohol and Tobacco Use (%): U.S. and Missouri Grades 9-12, 1995-2009 B7

Illicit Drug Use (%): U.S. and Missouri Grades 9-12, 1995-2009 B8

Behavioral Risk Factor Survey -- TablesAlcohol and Tobacco Use (%): U.S. and Missouri Ages 18 and Older, 2001-2010 B9

Monitoring the Future Survey -- TablesDaily, Past 30-Day, and Lifetime Substance Use (%): U.S. Grade 8, 1999-2010 B10

Daily, Past 30-Day, and Lifetime Substance Use (%): U.S. Grade 10, 1999-2010 B11

Daily, Past 30-Day, and Lifetime Substance Use (%): U.S. Grade 12, 1999-2010 B12

Daily, Past 30-Day, and Lifetime Substance Use (%): U.S. College Students, 1998-2009 B13

Daily, Past 30-Day, and Lifetime Substance Use (%): U.S. Young Adults 19-28, 1998-2009 B14

Missouri Student Survey -- TablesPast 30-Day Substance Use (%): Missouri Students in Grades 6-12, 2004-2010 B15

Lifetime Substance Use (%): Missouri Students in Grades 6-12, 2004-2010 B16

Missouri College Health Behavior Survey -- TablesPast-Year Substance Use and Related Measures (%): Missouri College Students, 2010 B17

Past-Year Mental Health Measures (%): Missouri College Students, 2010 B18

Past-Year Gambling Measures (%): Missouri College Students, 2010 B19


SECTION B: UNITED STATES AND MISSOURI PREVALENCE SURVEYS IN TABLES AND CHARTS (continued)

Alcohol Use -- Charts with TablesPast-Month Alcohol Use (%): U.S. and Missouri Age Group Comparisons, 1999-2008 B20

Past-Month Binge Drinking (%): U.S. and Missouri Age Group Comparisons, 1999-2008 B21

Perceived Risk of Binge Drinking (%): U.S. and Missouri Age Group Comparisons, 1999-2008 B22

Alcohol Use, Binge Use, and Perceived Risk (%): Missouri Age Group Comparisons, 1999-2008 B23

Alcohol Use, Binge Use, and Perceived Risk (%): Missouri ADA Regions B24

Past 30-Day Alcohol Use (%): U.S. and Missouri Students in Grades 9-12, 1995-2009 B25

Past 30-Day Binge Alcohol Use (%): U.S. and Missouri Students in Grades 9-12, 1995-2009 B26

Past 30-Day, Binge, and Early Alcohol Use (%): Missouri Grades 9-12 Comparisons, 1995-2009 B27

Past 30-Day, Binge, and Lifetime Alcohol Use (%): Missouri Students in Grades 6-12, 2004-2010 B28

Past-Month Alcohol Use (%): Missouri Age Group and Grade Level Comparisons B29

Past 30-Day and Past 2-Week Binge Alcohol Use (%): Missouri College Students, 2003-2010. B30

Tobacco Use -- Charts with TablesPast-Month Cigarette Use (%): U.S. and Missouri Age Group Comparisons, 1997-2007 B31

Past-Month Tobacco and Cigarette Use and Perceived Risk (%): Missouri ADA Regions B32

Past 30-Day Cigarette Use (%): U.S. and Missouri Students in Grades 9-12, 1995-2007 B33

Past 30-Day and Lifetime Tobacco Use (%): Missouri Students in Grades 6-12, 2004-2010 B34

Past-Month Cigarette Use (%): Missouri Age Group and Grade Level Comparisons B35

Illicit Drug Use -- Charts with TablesPast-Month Illicit Drug Use (%): U.S. and Missouri Age Group Comparisons, 1999-2008 B36

Past-Month Marijuana Use (%): U.S. and Missouri Age Group Comparisons, 1999-2008 B37

Perceived Risk of Smoking Marijuana (%): U.S. and Missouri Age Group Comparisons, 1999-2008 B38

Past-Month, First Use, and Perceived Risk of Marijuana Use (%): Missouri Age Groups B39

Past-Month, First Use, and Perceived Risk of Marijuana Use (%): Missouri ADA Regions B40

Past 30-Day Marijuana Use (%): U.S. and Missouri Students in Grades 9-12, 1995-2009 B41

First Use of Marijuana Before Age 13 (%): U.S. and Missouri Students in Grades 9-12, 1995-2009 B42

Past 30-Day and Lifetime Marijuana Use: Missouri Students in Grades 6-12, 2004-2010 B43

Past-Month Marijuana Use (%): Missouri Age Group and Grade Level Comparisons B44

Past-Year Cocaine Use (%): U.S. and Missouri Age Group Comparisons, 1999-2008 B45

Past 30-Day and Lifetime Cocaine Use (%): Missouri Students in Grades 6-12, 2004-2010 B46

Past-Year Non-Medical Pain Reliever Use (%): U.S. and Missouri Age Group Comparisons, 2004-2008 B47

Past 30-Day and Lifetime Stimulant Use (%): Missouri Students in Grades 6-12, 2004-2010 B48

Past 30-Day and Lifetime Inhalant Use (%): Missouri Students in Grades 6-12, 2004-2010 B49

Past 30-Day and Lifetime Hallucinogen Use (%): Missouri Students in Grades 6-12, 2004-2010 B50

Past 30-Day and Lifetime Ecstasy/Club Drug Use (%): Missouri Students in Grades 6-12, 2004-2010 B51

Lifetime Non-Prescription Steroid Use (%): Missouri Students in Grades 6-12, 2004-2010 B52

Lifetime Injection Drug Use (%): Missouri Students in Grades 6-12, 2004-2010 B53

Past-Year Illicit Drug Use (%): Missouri College Students, 2003-2010 B54

Alcohol and Illicit Drug Dependence and Abuse -- Charts with TablesAlcohol or Illicit Drug Dependence or Abuse (%): U.S. and Missouri Age Groups, 1999-2008 B55

Alcohol or Illicit Drug Dependence or Abuse (#): Missouri Age Groups, 1999-2008 B56

Alcohol or Illicit Drug Dependence or Abuse (#): ADA Regions by Gender and Age Group, 2005/2006 B57

Unmet Need for Alcohol and Drug Treatment (#): Missouri Age Groups, 2002-2008 B59

Unmet Need for Alcohol and Drug Treatment (%): Missouri ADA Regions, 2004-2008 B60

Unmet Need for Alcohol and Drug Treatment (%): Missouri ADA Regions and Age Groups, 2004-2008 B61

Mental Health Problems -- Charts with TablesPast-Year Serious Psychological Distress (%): U.S. and Missouri Age Group Comparisons, 2001-2007 B62

Past-Year Major Depressive Episode (%): U.S. and Missouri Age Group Comparisons, 2005-2008 B63

Past-Year Major Depressive Episode (%): Missouri and ADA Regions for Ages 12-17, 2008 B64

2011 Status Report on Missouri's Substance Abuse and Mental Health Problems Page A-62011 Status Report on Missouri s Substance Abuse and Mental Health Problems Page A-6

SECTION C: SUBSTANCE ABUSE INDICATORS IN TABLES AND CHARTS

Missouri Births and Fetal Exposure to Alcohol, Tobacco, and Other Drugs, 1996-2009 C1

Missouri Alcohol and Drug Related Hospitalizations and Emergency Department Episodes, 1999-2009 C2

Missouri Diseases Associated with Substance Abuse, 1999-2009 C3

Missouri Alcohol, Drug, and Smoking Induced Deaths, 1999-2009 C4

Missouri Alcohol Involved Traffic Crashes, 1998-2009 C5

Missouri Drug Involved Traffic Crashes, 1998-2009 C6

Missouri Alcohol and Drug Arrests, 2001-2009 C7

Missouri Alcohol and Drug Related Out-of-Home Placements and Juvenile Court Referrals, 1997-2009 C8

Missouri Criminal Justice Services for Alcohol and Drug Offenses, FY2001-FY2010 C9

Missouri Per Capita Consumption of Beverage Alcohol Based on Sales, 1970-2008 C10

Missouri Liquor Licenses, 1995-2010 C11

Missouri Tobacco Consumption Based on Sales Revenue, FY2001-FY2010 C12

Unemployment in the United States and Missouri, 1990-2010 C13

Economic Costs of Substance Abuse in the United States and Missouri C14

SECTION D: DIVISION OF ALCOHOL AND DRUG ABUSE STATEWIDE TREATMENT ADMISSIONS

Treatment Admissions Overview, FY2008-FY2010 D1

Male Treatment Admissions, FY2010 D2

Female Treatment Admissions, FY2010 D3

Alcohol Admissions, FY2010 D4

Marijuana Admissions, FY2010 D5

Cocaine Admissions, FY2010 D6

Methamphetamine Admissions, FY2010 D7

Heroin Admissions, FY2010 D8

Other Drug Admissions, FY2010 D9

Age Profiles of Treatment, SATOP, and Codependency Services Admissions, FY2010 D10


SECTION E: INDICATORS AND TREATMENT ADMISSIONS BY GEOGRAPHIC AREA

MissouriStatewide Missouri E1-E4

Missouri CountiesAdair E5-E8 Grundy E161-E164 Perry E317-E320

Andrew E9-E12 Harrison E165-E168 Pettis E321-E324

Atchison E13-E16 Henry E169-E172 Phelps E325-E328

Audrain E17-E20 Hickory E173-E176 Pike E329-E332

Barry E21-E24 Holt E177-E180 Platte E333-E336

Barton E25-E28 Howard E181-E184 Polk E337-E340

Bates E29-E32 Howell E185-E188 Pulaski E341-E344

Benton E33-E36 Iron E189-E192 Putnam E345-E348

Bollinger E37-E40 Jackson E193-E196 Ralls E349-E352

Boone E41-E44 Jasper E197-E200 Randolph E353-E356

Buchanan E45-E48 Jefferson E201-E204 Ray E357-E360

Butler E49-E52 Johnson E205-E208 Reynolds E361-E364

Caldwell E53-E56 Knox E209-E212 Ripley E365-E368

Callaway E57-E60 Laclede E213-E216 St. Charles E369-E372

Camden E61-E64 Lafayette E217-E220 St. Clair E373-E376

Cape Girardeau E65-E68 Lawrence E221-E224 Ste. Genevieve E377-E380

Carroll E69-E72 Lewis E225-E228 St. Francois E381-E384

Carter E73-E76 Lincoln E229-E232 St. Louis County E385-E388

Cass E77-E80 Linn E233-E236 Saline E389-E392

Cedar E81-E84 Livingston E237-E240 Schuyler E393-E396

Chariton E85-E88 McDonald E241-E244 Scotland E397-E400

Christian E89-E92 Macon E245-E248 Scott E401-E404

Clark E93-E96 Madison E249-E252 Shannon E405-E408

Clay E97-E100 Maries E253-E256 Shelby E409-E412

Clinton E101-E104 Marion E257-E260 Stoddard E413-E416

Cole E105-E108 Mercer E261-E264 Stone E417-E420Cole E105-E108 Mercer E261-E264 Stone E417-E420

Cooper E109-E112 Miller E265-E268 Sullivan E421-E424

Crawford E113-E116 Mississippi E269-E272 Taney E425-E428

Dade E117-E120 Moniteau E273-E276 Texas E429-E432

Dallas E121-E124 Monroe E276-E280 Vernon E433-E436

Daviess E125-E128 Montgomery E281-E284 Warren E437-E440

DeKalb E129-E132 Morgan E285-E288 Washington E441-E444

Dent E133-E136 New Madrid E289-E292 Wayne E445-E448

Douglas E137-E140 Newton E293-E296 Webster E449-E452

Dunklin E141-E144 Nodaway E297-E300 Worth E453-E456

Franklin E145-E148 Oregon E301-E304 Wright E457-E460

Gasconade E149-E152 Osage E305-E308 St. Louis City E461-E464

Gentry E153-E156 Ozark E309-E312

Greene E157-E160 Pemiscot E313-E316


SECTION E: INDICATORS AND TREATMENT ADMISSIONS BY GEOGRAPHIC AREA (continued)

ADA Planning Regions and Service AreasADA Northwest Region E465-E466 ADA Service Area 8 E483-E484 ADA Service Area 17 E501-E502

ADA Central Region E467-E468 ADA Service Area 9 E485-E486 ADA Service Area 18 E503-E504

ADA Eastern Region E469-E470 ADA Service Area 10 E487-E488 ADA Service Area 19 E505-E506

ADA Southwest Region E471-E472 ADA Service Area 11 E489-E490 ADA Service Area 20 E507-E508

ADA Southeast Region E473-E474 ADA Service Area 12 E491-E492 ADA Service Area 21 E509-E510

ADA Service Area 1 E475-E476 ADA Service Area 13 E493-E494 ADA Service Area 22 E511-E512

ADA Service Area JC E477-E478 ADA Service Area 14 E495-E496 ADA Service Area SL E513-E514

ADA Service Area 6 E479-E480 ADA Service Area 15 E497-E498

ADA Service Area 7 E481-E482 ADA Service Area 16 E499-E500

CPS Districts and Service AreasCPS Western District E515 CPS Service Area 9 E524 CPS Service Area 17B E533

CPS Central District E516 CPS Service Area 10 E525 CPS Service Area 18 E534

CPS Eastern District E517 CPS Service Area 11 E526 CPS Service Area 19 E535

CPS Service Area 1 E518 CPS Service Area 12 E527 CPS Service Area 20 E536

CPS Service Areas 2-5 E519 CPS Service Area 13 E528 CPS Service Area 21 E537



CPS Service Area 8A E522 CPS Service Area 16 E531 CPS Service Area 24-25 E540

CPS Service Area 8B E523 CPS Service Area 17A E532

SECTION F: APPENDIX

Missouri Population Estimates by Age, Gender, Race, and Hispanic Origin: 2009 F1

Map of Missouri Substate Areas Containing Estimates from National Survey on Drug Use and Health F2

Map of ADA Regions and Service Areas Containing Status Report Data F3

Map of CPS Adult Districts and Service Areas Containing Status Report Data F4

Data Sources F5

2010 Status Report on Missouri's Alcohol and Drug Abuse Problems Page A-9p g g


HIGHLIGHTS

PREVALENCE OF SUBSTANCE ABUSE While illicit drug use rates are beginning to rise in the United States, drug use among Missouri

adolescents continues to decline. Using two years of combined data, the latest report from the National

Survey on Drug Use and Health estimates that 8.35% of adolescents and adults in the U.S. – and 7.56%

of those in Missouri – currently use an illicit drug. However, among Missouri adolescents 12‐17 years of

age, illicit drug use has declined to the lowest rate reported in the 10‐year history of the state estimates.

National rates for past‐month alcohol use also edged up in 2008/2009, but decreased in Missouri for all

age groups. Current alcohol use among Missouri adolescents 12‐17 years of age dropped to an

estimated 13.76% — the lowest rate reported for Missouri adolescents in the 10‐year history of the

survey’s state estimates. Among young adults 18‐25 years of age, Missouri’s drinking rate declined to an

estimated 60.99% and dipped slightly below the national rate of 61.51% for that age group for the first

time.

Data Source: Substance Abuse and Mental Health Services Administration (SAMHSA), National Survey on Drug Use and Health.

The survey estimates that 439,000 Missouri residents have an alcohol or illicit drug dependency or abuse problem. They consist of 35,000 adolescents, 133,000 young adults, and 271,000 adults older than age 25. An estimated 316,000 have a problem with alcohol, 66,000 with illicit drugs, and 57,000 with both alcohol and illicit drugs.

Data Source: SAMHSA, National Survey on Drug Use and Health.

19991999‐2000

2000‐2001

20022002‐2003

2003‐2004

2004‐2005

2005‐2006

2006‐2007

2007‐2008

2008‐2009

Alcohol: U.S. Ages 12‐17 16.6 16.40 16.83 17.63 17.67 17.65 17.06 16.58 16.28 15.27 14.66

Alcohol: MO Ages 12‐17 15.7 16.06 18.01 19.53 19.67 20.20 19.96 17.55 16.28 14.90 13.76

Illicit Drug: U.S. Ages 12‐17 9.9 9.79 10.32 11.63 11.44 10.92 10.25 9.84 9.66 9.40 9.65

Illicit Drug: MO Ages 12‐17 8.9 8.23 9.94 10.16 10.05 10.99 10.92 9.96 9.49 8.78 8.05

0

5

10

15

20

25

Percent of Age Group

Estimated Past‐Month Alcohol and Illicit Drug Use Among U.S. and Missouri Adolescents

1999‐2000 2000‐2001 2002 2002‐2003 2003‐2004 2004‐2005 2005‐2006 2006‐2007 2007‐2008 2008‐2009

MO Ages 12‐17 39,000 39,000 42,000 45,000 51,000 48,000 43,000 40,000 39,000 35,000

MO Ages 18‐25 95,000 103,000 148,000 149,000 155,000 161,000 165,000 146,000 144,000 133,000

MO Ages 26+ 152,000 158,000 220,000 254,000 293,000 276,000 269,000 277,000 274,000 271,000

0

100,000

200,000

300,000

Estimated Number of Missouri Residents Abusing or Dependent on Alcohol or Illicit Drugs


PREVALENCE OF MENTAL ILLNESS

One‐fifth of Missouri adults had some form of mental illness in the past year. Based on recent data

from the National Survey on Drug Use and Health (NSDUH), an estimated 20.86% of Missouri residents

age 18 and older had any past‐year mental illness. This is slightly higher than the U.S. rate of 19.67% and

also higher than the overall rate for states in the Midwest. Among the 921,000 Missouri adults with

mental illness, 229,000 had serious mental illness, 172,000 had serious thoughts of suicide, 314,000 had

at least one major depressive episode, and 484,000 had serious psychological distress. Many individuals

had more than one type of mental health problem. Young adults 18‐25 years of age accounted for 24%

of the total, but 28% of those with serious psychological distress. Adults older than age 25 constituted

82% of those with a past‐year major depressive episode.

Data Source: SAMHSA, National Survey on Drug Use and Health.

Nationwide, almost 20% of adults with any mental illness also have a substance use disorder, identified

as past‐year dependence on, or abuse of, alcohol or an illicit drug. This co‐occurrence has a rate of

25.7% among individuals with serious mental illness. Projecting from the national data, approximately

181,000 Missouri adults have co‐occurring mental illness and substance use disorder — 45% of

Missouri’s 404,000 adults with substance abuse problems. Among the 181,000, nearly one‐third have

serious mental illness.

Mental Illness: 921,0 00

Serious Mental Illness: 229,000

Co-Occurr ing Mental Illness and Substance Use Disorder: 181,000 (projected)

Serious Mental Illness and Substance Use Disorder: 59,000 (projected)

Substance Use Disorder: 404,000

Data Source: SAMHSA, National Survey on Drug Use and Health. Missouri estimates for prevalence of co‐occurring mental illness

and substance abuse are projected from U.S. rates.

921,000

229,000 172,000314,000

484,000

0

200,000

400,000

600,000

800,000

1,000,000

AnyMentalIllness

SeriousMentalIllness

SeriousThoughtsof Suicide

MajorDepressiveEpisode

SeriousPsychological

Distress

Past Year Mental Illness among Missouri Adults Ages 18 and Older, 2009

Estimated Numbers of Missouri Residents with Past‐Year Mental Illness and Substance Abuse, 2009


SUBSTANCE ABUSE AND MENTAL ILLNESS RELATED DEATHS

Intentional deaths in Missouri are increasing. Missouri had 54,064 total resident deaths in 2009. These

included 857 suicides, 440 homicides, and 2,275 deaths originating from other mental or behavioral

disorders—primarily dementia with 2,078 deaths. Suicide reached its highest rate of the past decade at

158 per 10,000 population, while homicide posted the decade’s second‐highest rate at 81 per 10,000.

Mental conditions resulting in smaller numbers of deaths included depression, schizophrenia, mental

retardation, brain disease, anxiety, eating disorders, stress, and bipolar disorder.

Data Source: Missouri Department of Health and Senior Services, Missouri Vital Statistics.

The suicides included 120 intentional poisonings using illicit drugs or medications and fewer than five

using alcohol. Altogether Missouri had 372 alcohol‐induced deaths, 901 drug‐induced deaths, and 9,655

smoking‐related deaths in 2009. Accidental poisoning by narcotics and unspecified drugs and medicines

accounted for most of the increase in drug related deaths in recent years.

Data Source: Missouri Department of Health and Senior Services, special data tabulations.

Also in 2009, Missouri had 264 traffic crash deaths involving alcohol‐impaired drivers or pedestrians, 57

deaths in crashes involving drug impairment, and 5 boating fatalities attributed to intoxication. Annually,

there are an unspecified number of non‐traffic deaths resulting from the behavioral effects of excessive

alcohol and drug use. These include impairment‐related homicide, suicide, drowning, fire, fall, aviation,

and firearm incidents.

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Suicides 698 697 736 690 691 728 731 798 810 775 857

Homicides 382 391 423 371 333 381 429 412 394 486 440

0

200

400

600

800

1,000

Missouri Intentional Deaths, 1999‐2009

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Drug Induced Deaths 287 334 380 455 561 591 674 810 774 804 901

Alcohol Induced Deaths 398 329 358 334 335 385 329 379 316 387 372

0

200

400

600

800

1,000

Missouri Alcohol and Drug Induced Deaths, 1999‐2009


SUBSTANCE ABUSE RELATED HOSPITAL EPISODES

Alcohol and drug related emergency room episodes and per capita rates have increased during the

past decade. Alcohol related ER episodes involving Missouri residents increased from nearly 32,000 in

year 2000 to 49,000 in 2009. During this period, the population‐based rate increased from 57 per 10,000

to 81 per 10,000. The number of drug related episodes more than doubled, and the rate increased from

29 per 10,000 population in 2000 to 61 per 10,000 in 2009.

Data Source: Missouri Department of Health and Senior Services.

Emergency room services were used with 60% of the alcohol related and 54% of the drug related

hospitalizations in 2008. Among the drug related ER and hospital services, almost one‐half did not

identify a specific drug in the first‐listed drug diagnosis. Marijuana, cocaine, and heroin accounted for

most of the specified drugs.

Data Source: Missouri Department of Health and Senior Services.

0

10

20

30

40

50

60

70

80

90

0

10,000

20,000

30,000

40,000

50,000

60,000

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

E.R. EpisodesPer 10,000 Pop.Based on AnnualCensus Estimates

Number ofE.R. Episodes

Alcohol and Drug Related Emergency Room Episodes and Per Capita Rates, 2000‐2009

Alcohol ER Episodes Drug ER Episodes Alcohol ER Per Capita Drug ER Per Capita

Heroin/Opiates11%

Other Analgesics1%

Sedative‐hypnotics2%

Other Depressants1%Cocaine

13%

Amphetamines/Stimulants

4%Marijuana

18%

Hallucinogens<1%

Drug Combinations2%

Unspecified Drug48%

Drug Related Hospitalizations and ER Episodes by Drug Category, 2008


SUBSTANCE ABUSE RELATED TRAFFIC CRASHES

Alcohol‐related traffic crashes continue to decline, and drug‐related crashes are increasing. Missouri

recorded 6,832 traffic crashes involving alcohol‐impaired drivers and 1,207 involving drug‐impaired

drivers in 2009.

Data Source (all charts on this page): Missouri State Highway Patrol, Statistical Analysis Center.

These crashes caused 274 deaths and 4,038 injuries in 2009.

In 2009, impaired drivers in alcohol and drug involved traffic crashes had a median age of 30.

2004 2005 2006 2007 2008 2009

Alcohol Involved Crashes 7,799 7,430 7,516 7,380 6,955 6,832

Drug Involved Crashes 935 936 979 1,042 1,002 1,207

0

2,000

4,000

6,000

8,000

Number of Crashes

Missouri Traffic Crashes Involving Alcohol and Drug Impaired Drivers, 2004‐2009

0

50

100

150

200

250

300

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

2004 2005 2006 2007 2008 2009

KilledInjured

Numbers Killed and Injured in Missouri Crashes Involving Alcohol and Drug Impaired Drivers

Injured in Alcohol Crashes Injured in Drug Crashes Killed in Alcohol Crashes Killed in Drug Crashes

0

100

200

300

400

500

14 18 22 26 30 34 38 42 46 50 54 58 62 66 70 74 78 82 86

Number ofImpairedDrivers

Ages of Impaired Drivers

Age Distribution of Impaired Drivers in Alcohol and Drug Involved Missouri Traffic Crashes, 2009

Drug Involved

Alcohol and Drug Involved

Alcohol Involved


ALCOHOL AND DRUG ARRESTS

Alcohol and drug arrests are declining in Missouri. Based on the FBI’s Uniform Crime Reports, there

were 34,946 arrests for driving under the influence in 2009 compared to a peak of 42,041 in 2002.

Arrests for liquor law violations totaled 13,801 in 2009 compared to more than 15,000 in 2006 and 2007,

and most of the arrests for public intoxication occurred in the first half of the decade.

Data Source: Federal Bureau of Investigation, Uniform Crime Reports.

Arrests for possession of marijuana reached 22,608 in 2006 before declining to 20,709 in 2009. There

were 2,030 arrests for possession of cocaine, opium, and their derivatives (including heroin) in 2009

compared to almost 4,000 in 2003 and 2004. Arrests for possession of other non‐narcotic illicit drugs

totaled 6,563 in 2009 after reaching a peak of 11,173 in 2006, while total arrests for sale or manufacture

of illicit drugs were highest in 2002.

Data Source: Federal Bureau of Investigation, Uniform Crime Reports.

0

10,000

20,000

30,000

40,000

50,000

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Alcohol Arrests in Missouri, 2001‐2010

Liquor Law Violations

Drunkenness

Driving Under Influence

0

5,000

10,000

15,000

20,000

25,000

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Drug Possession Arrests in Missouri, 2001‐2010

Marijuana

Opium, Heroin, Cocaine

Synthetic Narcotics

Other Non‐Narcotic Drugs

0

1,000

2,000

3,000

4,000

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Drug Sale or Manufacturing Arrests in Missouri, 2001‐2010

Marijuana

Opium, Heroin, Cocaine

Synthetic Narcotics

Other Non‐Narcotic Drugs


JUVENILE COURT ALCOHOL AND DRUG RELATED SERVICES

Missouri juvenile court referrals for alcohol and drug offenses have declined to their lowest level since

1994. Drug violations comprised 65% — and alcohol violations 35% — of the 3,884 substance‐related

adolescent referrals in 2009. Total law violation referrals have decreased an average of 3.9% annually

since 1999, declining to 32,192 in 2009. During that same 10‐year period, average annual reductions in

juvenile court referrals have been 1.5% for alcohol violations and 2.7% for drug violations.

Data Sources: Missouri Department of Social Services and Missouri Office of State Courts Administrator.

Missouri court‐ordered out‐of‐home placements of children increased to 5,620 in 2009. Parental

substance abuse was a contributing reason for nearly one‐third of these removals. During the past 10

years, 27% of the 56,662 out‐of‐home placements have involved parental drug abuse and 8% have

involved parental alcohol abuse.

Data Source: Missouri Department of Social Services.

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

Trend in Missouri Juvenile Court Referrals for Alcohol and Drug Offenses

Drug

Alcohol

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Removals Alcohol or Drug Related 1375 1576 1748 1625 1884 2296 1968 1719 1694 1823

Removals Not Alcohol or Drug Related 3940 4378 4331 3842 3768 4149 3707 3479 3563 3797

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

Number ofOut‐of‐HomePlacements

Juvenile Court Out‐of‐Home Placements of Missouri ChildrenDue to Parental Substance Abuse and Other Reasons


CORRECTIONS SUPERVISION

Drug offenses constitute a large portion of Missouri prison admissions and probation and parole

caseload admissions. Among Missouri residents receiving Department of Corrections assignments in

fiscal year 2010 (July 1, 2009 – June 30, 2010), drug convictions accounted for more than 33% of all

probation admissions, 30% of the prison admissions, and 29% of the parole admissions. Convictions for

driving while intoxicated (DWI) comprised nearly 7% of the probation admissions, 7% of the prison

admissions, and 4% of the parole admissions.

Data Source (all charts on this page): Missouri Department of Corrections.

While annual prison admissions and probation and parole assignments for DWI have shown little recent

change, those for drug convictions have declined since mid‐decade.

Among the 17,013 Missouri resident drug conviction admissions combined (probation, prison, and

parole), the median age was 31. The 3,259 Missouri residents admitted for driving while intoxicated

convictions were considerably older, with a median age of 42.

Drug Convictions

33.5%

DWI Convictions

6.7%

All Other Convictions

59.9%

Probation Caseload Admissions, FY 2010

Drug Convictions

30.5%DWI

Convictions 6.7%

All Other Convictions

62.8%

Prison Admissions, FY 2010

0

5,000

10,000

15,000

State Prison and Probation and Parole Admissions for Drug and DWI Convictions, FY2001‐FY2010

Probation & Parole for Drug Convictions Prison for Drug Convictions

Probation & Parole for DWI Convictions Prison for DWI Convictions

0

200

400

600

800

16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67 70 73

Number ofAdmissions

Age at Admission

Combined Probation, Prison, and Parole Admissions for Drug and DWI Convictions by Age, FY 2010

Drug Offense Admissions

Driving While Intoxicated Admissions


SUBSTANCE ABUSE TREATMENT SERVICES

Nearly 75,000 individuals began substance abuse treatment or other services funded through the

Division of Alcohol and Drug Abuse in fiscal year 2010. These included almost 30,000 males (median

age 38) and 13,000 females (median age 35) who entered substance abuse clinical treatment programs,

30,000 who received a Substance Abuse Traffic Offender Program (SATOP) assessment including a

clinical or educational referral, and 2,000 who received co‐dependency or compulsive gambling services.

Adolescent treatment admissions have decreased in recent years, while admissions for older adults

continue to increase annually. Individuals age 55 and older comprised over 4% of the fiscal year (FY)

2010 treatment admissions. Males comprised 70% of the clinical admissions and females 30%, but this

ratio varied by type of drug. Among those with primary problems of alcohol or marijuana, more than

70% were males. Females had proportionally more admissions for methamphetamine, heroin, and

cocaine, and almost one‐half of the admissions for other illicit and prescription drugs.

Data Source: Missouri Department of Mental Health, CIMOR system.

Admissions for heroin treatment increased almost 22% in FY 2010 compared to FY 2009, continuing a

multi‐year upward trend. Powder cocaine and crack cocaine each had 17% decreases in admissions,

while methamphetamine admissions increased 4%. Alcohol admissions remained virtually unchanged

from FY 2009 but still accounted for 41% of the total. Marijuana admissions decreased 2.5% and

remained second. Treatment for a variety of other street drugs and pharmaceuticals constituted nearly

8% of the admissions. More than 4,000 individuals entering treatment were injection drug users.


0

1,600

12 15 18 21 24 27 30 33 36 39 42 45 48 51 54 57 60 63 66 69 72 75 78

Number ofIndividuals

Age at Admission to Treatment

Age Distribution of Missouri ADA Clinical Treatment Admissions by Gender, Fiscal Year 2010

Female

Male

0

18,000

Alcohol Marijuana Cocaine Methamphetamine Heroin All Other

TreatmentAdmissions

Primary Drug of Abuse in ADA Treatment Admissions, Fiscal Years 2006‐2010

FY 2006

FY 2007

FY 2008

FY 2009

FY 2010


MENTAL ILLNESS TREATMENT SERVICES

More than 73,000 individuals accessed mental health treatment through the Division of Comprehensive Psychiatric Services in fiscal year 2010. Almost equal numbers were male (49%) and female (51%). Caucasians comprised 72% of the total, African Americans 22%, Hispanics 2%, and other races/ethnicities 4%. Children and adolescents under age 18 comprised 15% of the total. Adults in their late 40’s were the most served and had the highest treatment rate, with 1.9% of Missouri’s population in that age group receiving mental health services.


Among consumers with a listed diagnosis, over 40% had a mood disorder, 17% sought treatment for

anxiety, and 15% had a psychotic disorder. Smaller numbers received psychiatric treatment for impulse

control disorders, co‐occurring mental illness and substance abuse, and other types of disorders.


Nearly 60% of individuals admitted to ADA substance abuse programs — but less than 8% of those

served in CPS programs — were referred by criminal justice agencies. One‐half of the CPS consumers

entered treatment through a self‐referral or were referred by family or friends, and 20% were referred

by a mental health or medical provider.

938

3,543

4,9385,781

7,2966,514 6,238 6,424

6,819

8,515

7,309

4,773 4,643

0

2,000

4,000

6,000

8,000

0‐5 6‐9 10‐13 14‐17 18‐24 25‐29 30‐34 35‐39 40‐44 45‐49 50‐54 55‐59 60+

NumberServed

Age Group

Individuals Served in CPS Treatment Programs in FY 2010, by Age Groups

Adjustment3%

Anxiety17%

Dementia<1%

Developmental1%

Inpulse Control10%

Mood41%

Personality8%

Psychotic15%

Sexual<1%

Other5%

Problems Identified among Consumers Receiving Mental Illness Treatment, Fiscal Year 2010


LOOKING AHEAD

During the past two decades, Missouri state agencies have annually prepared a variety of substance

abuse related data specifically to submit to the Status Report. Federal funding recently became available

to convene the Missouri Behavioral Health Epidemiology Workgroup (MO‐BHEW) and further develop

the state’s infrastructure of substance abuse, mental health, and other behavioral health data. The MO‐

BHEW has provided guidance in the development of a web tool to provide public access to archived and

future Status Report data. Users will be able to view trends and conduct basic data analysis to meet

their specific needs. The website will include the state agency data, Census Bureau population

estimates, prevalence data from the Missouri Student Survey, and U.S. and Missouri data from the

National Survey on Drug Use and Health. The web tool will be accessible from the MO‐BHEW home

page. Visit http://dmh.mo.gov/ada/mobhew/index.htm.

2011 Status Report on Missouri’s Alcohol and Drug Abuse Problems Page A-21

Introduction Survey data represent a valuable source of information on prevalence estimates, use and behavior

patterns, drug preferences, and emerging trends. Survey data, however, are not without limitations. No

single survey exists which covers all populations abusing substances. Substance abuse surveys typically

fall into the following categories: 1) household surveys, 2) criminal justice surveys, and 3) school surveys.

These surveys can miss segments of the population that have been impacted by substance abuse

including the incarcerated, the homeless, and school dropouts. The survey data are self‐report data and

have inherent validity concerns due to respondent dishonesty, forgetfulness, or poor comprehension.

Assessments of validity have been mixed. Research suggests that validity concerns are more evident for

the criminal justice population and for reporting use of some drugs such as cocaine and heroin that may

have an associated stigma. Nevertheless, collection of alcohol and drug use data via surveys provides

useful information on large diverse populations that would not otherwise be available. Characteristics

and highlights of the following survey data sources are provided:

Behavioral Risk Factor Survey (BRFS)

Core Alcohol and Drug Survey

Missouri College Health Behavior Survey (MCHBS)

Missouri Student Survey (MSS)

Monitoring the Future (MTF)

National Survey on Drug Use and Health (NSDUH)

Youth Risk Behavior Survey (YRBS)

Behavioral Risk Factor Survey (BRFS) Conducted by: Centers for Disease Control (CDC) in partnership with state health departments

Established: 1984

Frequency of Reporting: Annual

Type of survey: Household

Mode of survey: Telephone interview

Age groups: Ages 18 or older

Completed interviews: About 450,000 nationwide and 5,400 in Missouri.

Level of reporting: National, state, and Missouri Department of Health and Senior Services

planning regions

Some strengths: BRFS does include data on adult consumption of alcohol and use of tobacco.

BRFS has a relatively large sample size. The survey allows for year‐to‐year comparisons.

Some limitations: BRFS does not include data on drug use nor does it include adolescents in its

target population.


Other notes: BRFS definitions of binge drinkers and heavy drinkers differ from that of the

National Survey on Drug Use and Health (NSDUH) – BRFS definitions depend upon gender.

Website: http://www.cdc.gov/brfss and

http://cntysvr1.lphamo.org/pubdocs/brfss/index.php

Core Alcohol and Drug Survey Conducted by: Missouri Partners in Prevention

Established: 1990 for the University of Missouri, Columbia campus. Eleven other public

university campuses began implementation in 2001.


Type of survey: School/Higher Education

Mode of survey: Paper Questionnaire

Grade levels: Undergraduate students at 12 Missouri higher education institutions

Completed interviews: Varies by campus

Level of reporting: Campus level

Some strengths: Core captures data on attitudes, perceptions, and opinions about use of

alcohol and drugs in addition to use and consequences of use.

Some limitations: Core is used primarily as a tool at the local campus level.

Website: http://coreinst.siuc.edu/

Missouri College Health Behavior Survey (MCHBS) Conducted by: Missouri Partners in Prevention

Established: 2007 to replace annual Core Alcohol and Drug Survey


Type of survey: School/Higher Education

Mode of survey: On‐line Survey

Grade levels: Undergraduate students at 13 Missouri higher education institutions

Completed interviews: Varies by campus

Level of reporting: Campus level

Some strengths: The MCHBS measures attitudes, perceptions, and opinions about use of

alcohol and drugs in addition to use and consequences of use. Other behaviors surveyed include

gambling, safe driving, mental health issues, and tobacco use. Measure has been validity tested

against the Core Alcohol and Drug Survey with favorable results.

Some limitations: MCHBS is not a national survey.

Website: http://pip.missouri.edu/mchbs/


National Survey on Drug Use and Health (NSDUH) Conducted by: Substance Abuse and Mental Health Services Administration (SAMHSA)

Established: 1971, originally titled National Household Survey on Drug Abuse


Type of survey: Household

Mode of survey: Face‐to‐face interview

Age groups: Ages 12 or older

Completed interviews: 68,487 nationwide and about 900 in Missouri for 2010 survey.

Level of reporting: National but can also obtain state and sub‐state planning regions by

combining multiple survey years

Some strengths: NSDUH allows for year‐to‐year comparisons for national data and a rolling

multi‐year comparison for state and sub‐state data. In addition to substance use data, NSDUH

provides data on past year alcohol or illicit drug dependence or abuse.

Some limitations: NSDUH interviews household residents only, and the survey estimates are

based on these populations. Not represented in the surveys are prison and jail inmates, other

institutionalized individuals, and the homeless. Limited drug and demographic data are available

at the state level because of the small sample size. NSDUH does not separate out smokeless

tobacco and chewing tobacco. Age categories generally limited to 12‐17, 18‐25, and 26 and

older.

Other notes: NSDUH definitions of binge drinkers and heavy drinkers differ from that of the

Behavioral Risk Factor Survey (BRFS) – NSDUH definitions do not depend on gender.

Website: http://www.oas.samhsa.gov/nsduh.htm

Missouri Student Survey (MSS) Conducted by: Missouri Department of Mental Health (DMH)

Established: 2000

Frequency of Reporting: Every even numbered year

Type of survey: School

Mode of survey: Web‐based

Grade levels: Grades 6th through 12th but more concentrated on 9th grade

Completed interviews: 129,901 in 2010

Level of reporting: State and Missouri Division of Alcohol and Drug Abuse (ADA) planning

regions

Some strengths: MSS is offered to all Missouri public school districts. MSS includes the younger

middle school population in addition to the high school population. MSS also captures data on

risk and protective factors and antisocial behaviors in addition to substance use patterns.

Some limitations: Some school districts opt out of the survey. In 2010, 426 of the 522 districts

participated in some capacity, and 372 had sufficient sample sizes for district‐level analysis.

Caution must be used if combining grades because weighting is not applied. Data are only

available every other year.


Other notes: MSS definition of binge drinking is different than that of NSDUH. MSS combines

ecstasy with other club drugs which is different than NSDUH.

Website: http://www.dmh.missouri.gov/ada/rpts/survey.htm

Monitoring the Future (MTF) Conducted by: National Institute on Drug Abuse (NIDA)

Established: 1975



Mode of survey: Paper questionnaire

Grade levels: 8th, 10th, and 12th graders; college students; and young adults

Completed interviews: About 46,000 students nationwide

Level of reporting: National

Some strengths: MTF provides data on lifetime, past year, and past 30 day use of various illicit

drugs including methamphetamine. Questions regarding prescription drug use including use of

OxyContin, Vicodin, and Ritalin have been added in recent years. MTF also captures data on

perception of harm and disapproval.

Some limitations: MTF does not provide state level data.

Other notes:

Website: http://www.monitoringthefuture.org/

Youth Risk Behavior Survey (YRBS) Conducted by: Centers for Disease Control

Established: 1991

Frequency of Reporting: Every odd‐numbered year


Mode of survey: Paper questionnaire

Grade levels: 9th through 12th

Completed interviews: 16,460 nationwide and 1,624 in Missouri in 2009

Level of reporting: National and State

Some strengths: YRBS includes questions on alcohol, drug, and tobacco use. YRBS includes

questions on lifetime steroid use and lifetime IV drug use.

Some limitations: Some states do not participate in the YRBS ‐‐ three in 2009. YRBS does not

capture data on private schools or home‐school children. Current drug use limited to marijuana

and cocaine. Limited data are available at the state level due to small sample size. Data only

available every other year.

Other notes: YRBS definition of binge drinking similar to that of the National Survey on Drug

Use and Health (NSDUH).

Website: http://www.cdc.gov/HealthyYouth/yrbs/index.htm

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